JMIR公共卫生和监视

后COVID-19大流行时代COVID-19接触追踪应用程序的有效性、政策和用户接受度:经验与比较研究

2022 - 10 - 27 - t10:15:02内

背景:在COVID-19大流行后，许多国家都推出了追踪COVID-19感染接触者的应用程序。由于不同国家的联系人追踪政策或技术的不同，每个联系人追踪应用程序都面临着各种各样的问题。在这项研究中，我们旨在调查全球各国用于追踪接触者的所有CTA，包括每个CTA使用的技术，从官方网站获得CTA知识的情况，各国CTA的互操作性，以及启动CTA的具体国家的感染检出率和政策，并根据收集到的信息总结当前应用程序存在的问题。我们调查了通过谷歌、谷歌Scholar和PubMed在所有国家推出的cta。我们对所有可以安装的应用程序进行了实验，并通过查阅官方网站和以前的文献整理了不能安装或使用的应用程序的信息。我们将收集到的cta信息与以往的相关文献进行对比，以了解和分析数据。在筛选了全球197个国家开发的166个COVID-19应用程序后，我们从95个国家(48.2%)中选择了98个(59%)应用程序，其中63个(66.3%)应用程序可用。联系人追踪的方法主要分为三大类:蓝牙、地理定位和QR码。在技术层面，cta面临着3个主要问题。首先，基于蓝牙和地理位置的cta记录接触的距离和时间一般设置为2米15分钟; however, this distance should be lengthened, and the time should be shortened for more infectious variants. Second, Bluetooth- or geolocation-based CTAs also face the problem of lack of accuracy. For example, individuals in 2 adjacent vehicles during traffic jams may be at a distance of ≤2 meters to make the CTA trace contact, but the 2 users may actually be separated by car doors, which could prevent transmission and infection. In addition, we investigated infection detection rates in 33 countries, 16 (48.5%) of which had significantly low infection detection rates, wherein CTAs could have lacked effectiveness in reducing virus propagation. Regarding policy, CTAs in most countries can only be used in their own countries and lack interoperability among other countries. In addition, 7 countries have already discontinued CTAs, but we believe that it was too early to discontinue them. Regarding user acceptance, 28.6% (28/98) of CTAs had no official source of information that could reduce user acceptance. Conclusions: We surveyed all CTAs worldwide, identified their technological policy and acceptance issues, and provided solutions for each of the issues we identified. This study aimed to provide useful guidance and suggestions for updating the existing CTAs and the subsequent development of new CTAs.

对乙酰氨基酚在骨关节炎和腰痛患者中的应用:电子病历数据的信息流行病学研究和观察分析

2022 - 10 - 27 - t10:00:03内

背景:腰痛(LBP)和骨关节炎(OA)是常见的肌肉骨骼疾病，约占全球残疾年数的17.0%;然而，缺乏关于这些情况的真实数据。在法国，对乙酰氨基酚品牌经常被用于肌肉骨骼疼痛，包括Doliprane, Dafalgan和Ixprim(曲马多-对乙酰氨基酚)。目的:本回顾性研究的目的是了解LBP或OA患者在使用对乙酰氨基酚治疗时的旅程。方法:进行三项研究。两项研究分析了2013年至2018年期间在法国至少接受过一次扑热息痛处方的OA或LBP患者的全科医生(gp)和风湿病医生的电子医疗记录。数据被提取、匿名，并按性别、年龄和提供者专业进行分层。第三项研究是一项信息流行病学研究，分析了法国和美国的公共医疗论坛和Twitter上使用的术语之间的关联，仅针对OA。在前两项研究中，在LBP患者(98,998)中，大多数(n=92,068, 93.0%)看过全科医生，87.0% (n=86,128)的患者将多立普兰作为一线治疗(71.0% [n=61,151]联合非甾体抗炎药[NSAIDs]或阿片类药物)。在OA患者(99,997)中，大多数(n=84,997, 85.0%)看了全科医生，83.0% (n=82,998)的患者(62.0% [n=51,459]联合使用)使用多利普兰作为一线治疗。 Overall, paracetamol monotherapy prescriptions decreased as episodes increased. In the third study, in line with available literature, the data confirmed that the prevalence of OA increases with age (91.5% [212,875/232,650] above 41 years), OA is more predominant in females (46,530/232,650, 20.0%), and paracetamol use varies between GPs and rheumatologists. Conclusions: This health surveillance analysis provides a better understanding of the journey for patients with LBP or OA. These data confirmed that although paracetamol remains the most common first-line analgesic for patients with LBP and OA, usage varies among patients and health care specialists, and there are concerns over efficacy.

指导尼日利亚艾滋病毒疫情应对的关键人口规模估计:3源捕获-再捕获数据的贝叶斯分析

2022 - 10 - 26 - t10:15:25内

背景:尼日利亚是全球第四大艾滋病毒携带者。关键人群，包括女性性工作者、男男性行为者和注射毒品者，由于被污名化和被定罪的行为，比一般人群更容易感染艾滋病毒。需要可靠的关键人口规模估计，以指导艾滋病毒流行病应对工作。我们的研究目的是使用实证方法进行抽样和分析，以提高尼日利亚7个州(阿克瓦伊博姆、贝努埃、克罗斯河、拉各斯、纳萨罗瓦、河流和联邦首都地区)的女性性工作者、男性性行为者和注射吸毒者的人口规模估计质量，以进行项目规划，并展示改进的统计估计方法。2018年10月至12月，我们使用3源捕获-再捕获方法对尼日利亚7个州的人口规模进行了估计。在3源捕获-再捕获开始前绘制热点图。我们对女性性工作者、男男性行为者和注射毒品者进行了三次采样，时间间隔约为一周。在热点遭遇战中，每个捕获回合都会为关键群体成员提供便宜而难忘的独特物品。在随后的几轮中，向关键群体成员提供了一个物体，并要求他们识别在前几轮中收到的物体(如果有的话)。正确的回答被记录在平板电脑上。 Data were aggregated by key population and state for analysis. Median population size estimates were derived using Bayesian nonparametric latent-class models with 80% highest density intervals. Results: Overall, we sampled approximately 310,000 persons at 9015 hotspots during 3 independent captures. Population size estimates for female sex workers ranged from 14,500 to 64,300; population size estimates for men who have sex with men ranged from 3200 to 41,400; and population size estimates for people who inject drugs ranged from 3400 to 30,400. Conclusions: This was the first implementation of these 3-source capture-recapture methods in Nigeria. Our population size estimates were larger than previously documented for each key population in all states. The Bayesian models account for factors, such as social visibility, that influence heterogeneous capture probabilities, resulting in more reliable population size estimates. The larger population size estimates suggest a need for programmatic scale-up to reach these populations, which are at highest risk for HIV.

波多黎各由提供者发起的艾滋病毒检测来自国家艾滋病毒行为监测-异性恋周期(NHBS-HET) 2016年的数据:全国横断面调查

2022 - 10 - 26 - t10:15:03内

背景:根据美国疾病控制与预防中心和世界卫生组织的指导方针，所有13-64岁的人都应该接受艾滋病毒感染筛查，这是他们常规体检的一部分。高危人群应每年进行一次检测。目的:本研究旨在利用波多黎各国家艾滋病毒行为监测2016周期的数据，针对艾滋病毒感染风险增加的异性恋人群，确定由提供者发起的艾滋病毒检测的社会人口统计学、医疗保健和性行为特征。通过受访者驱动抽样，招募了358名符合条件的参与者样本，其中社会人口学特征、医疗保健使用和艾滋病毒检测转诊用于评估研究样本的描述。采用Pearson卡方检验和Fisher检验评价比例差异。进行多变量逻辑回归模型，以确定自变量与HIV检测转诊之间的关系。按性别和年龄调整的流行率及其95% ci使用0.05的统计学显著性水平确定。尽管67.9%(243/358)的参与者表现出高风险的性行为实践，67.4%(236/350)的参与者在过去12个月内访问过卫生保健提供者，报告艾滋病毒感染的低感知风险，80.7%(289/358)的研究样本在最近的医疗访问中没有接受艾滋病毒检测转诊。多变量分析显示，在报告从事高危性行为的参与者中，接受HIV检测转诊的参与者的估计患病率为41%(调整后患病率为0.59,95% CI为0.39 - 0.91;P=.02)低于那些没有从事高危性行为的人的估计患病率。 Conclusions: This sample of Puerto Rican adults reported a significantly lower prevalence of receiving an HIV test referral among heterosexual individuals at increased risk of HIV infection who engaged in high-risk behaviors. This study further emphasizes the need for health care providers to follow recommended guidelines for HIV test referrals in health care settings. Promotion practices in the future should include enhancing referral and access to HIV tests and implementing preventive measures to counteract the HIV epidemic in Puerto Rico.

荷兰城市COVID-19感染预测:算法开发和解释

2022 - 10 - 20 - t10:15:03内

2019年12月，中国武汉市首次发现COVID-19。该病毒迅速传播，并于2020年3月11日被宣布为大流行。感染后，会出现发烧、(干咳)、鼻塞和疲劳等症状。在某些情况下，该病毒会导致严重的并发症，如肺炎和呼吸困难，并可能导致死亡。这种病毒也在荷兰迅速传播，荷兰是一个人口密集、人口老龄化的小国。荷兰的卫生保健水平很高，但医院的能力存在问题，例如可用床位和工作人员的数量。还有一些地区和市政当局受到的打击比其他地区更严重。在荷兰，有重要的数据来源可用于每日COVID-19数字和有关市政当局的信息。我们的目标是使用具有荷兰355个市镇属性的数据集和先进的建模技术，预测荷兰每个市镇每万名居民中确诊的COVID-19累计感染人数。我们从荷兰公共领域可用的数据源中收集了每个城市的相关静态数据，并将这些数据与2020年1月1日至2021年5月9日的每日动态感染数合并，形成了一个包含荷兰355个城市的数据集，变量分为20个主题。 The modeling techniques random forest and multiple fractional polynomials were used to construct a prediction model for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants per municipality in the Netherlands. Results: The final prediction model had an R² of 0.63. Important properties for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants in a municipality in the Netherlands were exposure to particulate matter with diameters <10 μm (PM10) in the air, the percentage of Labour party voters, and the number of children in a household. Conclusions: Data about municipality properties in relation to the cumulative number of confirmed infections in a municipality in the Netherlands can give insight into the most important properties of a municipality for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants in a municipality. This insight can provide policy makers with tools to cope with COVID-19 and may also be of value in the event of a future pandemic, so that municipalities are better prepared.

更正:中国基于起始年龄和间隔的低剂量ct肺癌筛查的成本-效果:建模研究

2022 - 10 - 17 - t13:00:02内

中国基于缺勤和温度的流感综合征监测试点系统:开发和可用性研究

2022 - 10 - 14 - t10:15:03内

背景:目前中国基于学校的传染病综合征监测系统(SSS)存在的不足包括依赖校医手工收集数据，忽略在校生健康信息。本研究旨在设计并实现一个基于缺勤率(通过人脸识别收集)和在校学生体温(通过热成像测量)的流感SSS。方法:通过扩展现有应用程序的功能来实现SSS。该制度在长三角地区的2所小学和1所初中实施，共计3535名学生。考试周期为2021年3月1日至2022年1月14日，有效天数为174天。系统报告的每日和每周缺勤率和发烧率(DAR1和DFR;计算WAR1和WFR)。以校医上报的每日和每周缺勤率(DAR2和WAR2)和每周流感病毒阳性率(WPRIV，由中国国家流感中心发布)为标准，评估系统上报数据的质量。结果:校医报告的缺勤率(完整性86.7%)是本系统报告的缺勤率(完整性100%)的36.5%，两者之间存在显著正相关(r=0.372， P=.002)。流感活动水平中等时，DAR1s在学校间呈显著正相关(r_ab=0.508， P=.004; r_bc=0.427, P=.02; r_ac=0.447, P=.01). During the influenza breakout, the gap of DAR1s widened. WAR1 peaked 2 weeks earlier in schools A and B than in school C. Variables significantly positively correlated with the WPRIV were the WAR1 and WAR2 of school A, WAR1 of school C, and WFR of school B. The correlation between the WAR1 and WPRIV was greater than that between the WAR2 and WPRIV in school A. Addition of the WFR to the WAR1 of school B increased the correlation between the WAR1 and WPRIV. Conclusions: Data demonstrated that absenteeism calculation based on face recognition was reliable, but the accuracy of the temperature recorded by the infrared thermometer should be enhanced. Compared with similar SSSs, this system has superior simplicity, cost-effectiveness, data quality, sensitivity, and timeliness.

更正:谷歌2010 - 2021年美国人乳头瘤病毒疫苗搜索趋势:信息流行病学研究

2022 - 10 - 04 - t13:00:02内

网上HIV自检包的时空分布及其对中国HIV预防的影响:基于人群的研究

2022 - 10 - 04 - t10:30:55内

艾滋病毒自检(HIVST)为扩大艾滋病毒检测提供了巨大的希望。然而，关于艾滋病病毒行为的大规模数据却很少。每年通过电子商务平台销售数百万个艾滋病毒检测试剂盒。本研究旨在分析中国hiv - st试剂盒购买人群(HIVSTKPP)的时空分布。方法:从中国领先的电子商务平台检索未识别的交易数据。通过计算年平均百分比变化，使用连接点回归模型来检查HIVSTKPP发病率的年度趋势。采用贝叶斯时空分析方法定位HIVSTKPP发病率高的热点。通过空间自相关分析和时空聚类分析鉴定HIVSTKPP的聚类。通过空间自相关分析可以识别出高-高聚类，高-高聚类表明一个地区及其周边地区共同具有高于平均水平的HIVSTKPP发病率。通过空间回归分析，阐明HIV检测设施数量、城镇化率(城市人口占总人口的比例)、人均国内生产总值(gdp)和艾滋病病毒感染kpp之间的关系。 Results: Between January 1, 2016, and December 31, 2019, a total of 2.18 million anonymous persons in China placed 4.15 million orders and purchased 4.51 million HIVST kits on the web. In each of these 4 years, the observed monthly size of the HIVSTKPP peaked in December, the month of World AIDS Day. HIVSTKPP rates per 100,000 population significantly increased from 20.62 in 2016 to 64.82 in 2019 (average annual percentage change=48.2%; P<.001). Hot spots were mainly located in municipalities, provincial capitals, and large cities, whereas high-high clusters and high-demand clusters were predominantly detected in cities along the southeast coast. We found positive correlations between a region’s number of HIV testing facilities, urbanization ratio, and gross domestic product per capita and the HIVSTKPP. Conclusions: Our study identified key areas with larger demand for HIVST kits for public health policy makers to reallocate resources and optimize the HIV care continuum. Further research combining spatiotemporal patterns of HIVST with HIV surveillance data is urgently needed to identify potential gaps in current HIV-monitoring practices.

按居住社区和社会和结构决定因素划分的集中护理机构工作人员中的COVID-19病例:观察性研究

2022 - 10 - 04 - t10:30:03内

背景:在包括长期护养院、养老院和收容所在内的聚集护理设施中，COVID-19的风险过大，既影响设施工作人员感染SARS-CoV-2，也会受到其影响。在加拿大各城市，COVID-19病例的地理聚集一直呈一致趋势。然而，关于COVID-19在设施工作人员中如何反映城市社区差异的信息有限，特别是在按社区传播的社会和结构决定因素分层时。本研究旨在比较大多伦多地区(人口:710万)3个相互排斥的亚群体(其他环境中的社区、设施工作人员和卫生保健工作者)的地理、社会和结构决定因素累积病例的集中程度。我们利用实验室确诊的COVID-19病例的监测数据(2020年1月23日至12月13日;在疫苗推广之前)。我们从人口普查数据中导出了社区层面的社会和结构决定因素，并生成了洛伦兹曲线、基尼系数和胡佛指数，以可视化和量化情况下的不平等。结果:疫情最严重的社区(占总人口的20%)占社区病例的53.87%(44,937/83,419)，设施人员病例的48.59%(2356/4849)，其他HCW病例的42.34%(1669/3942)。与其他卫生工作者相比，设施人员之间的病例更能反映社区病例的分布。在所有决定因素中，设施工作人员的病例比其他卫生工作者反映出更大的社会和结构不平等(更大的基尼系数)。 Facility staff cases were also more likely than community cases to be concentrated in lower-income neighborhoods (Gini 0.24, 95% CI 0.15-0.38 vs 0.14, 95% CI 0.08-0.21) with a higher household density (Gini 0.23, 95% CI 0.17-0.29 vs 0.17, 95% CI 0.12-0.22) and with a greater proportion working in other essential services (Gini 0.29, 95% CI 0.21-0.40 vs 0.22, 95% CI 0.17-0.28). Conclusions: COVID-19 cases among facility staff largely reflect neighborhood-level heterogeneity and disparities, even more so than cases among other HCWs. The findings signal the importance of interventions prioritized and tailored to the home geographies of facility staff in addition to workplace measures, including prioritization and reach of vaccination at home (neighborhood level) and at work.